Thailand’s health services are among the best in the region. This improvement over the past 50 years is astounding. Any medical procedure that is standard elsewhere is available in this country, including the most advanced. Thailand is trying to become a “medical hub” and for 15 years has been striving to promote “medical tourism” where travelers come to Thailand for elective surgery as well as advanced treatment. These developments have promoted Thailand as a top-level retirement location as well.

In this essay I would like to ruminate on a lesser known aspect of health services development in Thailand, namely the spread of health care into the “hinterland.” My comments are personal observations, subject to review.

1.Primary medical care is now available to 80% of the population from where they live.2.Every one of Thailand’s 77 provinces has (or will soon have) a general hospital and most of the 900 districts () have a hospital open 24 hours with in-patient facilities and a doctor on site round the clock. Specialists come on rotation.3.There are international-class medical centers in every region of the country.4.The development of clinics with scheduled emergency health services in populated sub-districts is proceeding with extensive local support.5.Preventive health care and education about health risks are expanding to the point that average village residents are conversant about these topics.

VILLAGE HEALTH VOLUNTEERS (referred to by the initials อสม) are organized by the staffs of village clinics. The work of each volunteer organization receives directives from the district health department and financial support from the central government to give the volunteers a small monthly stipend. A local organization might have about 20 volunteers.

The volunteers meet monthly for strategy planning and health training. They are called on to assist in health campaigns such as the current, annual “deadly mosquito crusade” (my translation of the phrase). If an epidemic breaks out the volunteers’ first duty is to collect data and to spread the word about measures to be taken. If the epidemic is severe, as was the case with dengue fever in our village last year, the volunteers help provide back-up services for medical teams to descend. Any rise in health risks is probably first noted by volunteers. Diabetes, cancer, and heart disease are the 3 leading medical health issues in our village. The volunteers keep track of persons with elevated risk factors.

Over all, the health level of village residents has risen dramatically. Life expectancy has risen from 50 to 75 years in the last 50 years. Infant and early childhood mortality rates have dropped almost to zero.

I would argue that the most important contribution made by Village Health Volunteers is health awareness and neighborly concern. It would be hard to measure the effect of having 20 people in most every village know that blood sugar levels over 120 are dangerous, that blood pressure for older people ought to be about 130 over 90, and that stagnant water is where mosquitoes proliferate. Nutrition is the leading contributor to poor health for people in our village now that public sanitation is vastly improved. ​Village Health Volunteers are on the front line helping to expand health services to every village.

The changes have been most dramatic in the last 20 years. I didn't mention cost. This is not a single-payer system, but costs for most people for most care is easily manageable. Pa paid less than $30 for surgery and 5 days in the hospital.

Reply

Tim Downs

4/27/2018 03:58:02 pm

Ken,
Fascinating. In my visit to Cuba last year we had an extensive introduction to the health care system , including visit to clinics and the Latin American Medical School. There is a family doctor assigned to every 25 families, who keeps appointments only in the afternoon. The mornings are spent in the community doing house visits. The emphasis if the whole system is on health and preventing illness rather than responding only to illness as typically happens in the US. The network of clinics support the family doctors, and of course there are specialized hospitals. Mortality, infant mortality rates, life expectancy all exceed US statistics. This from a country which has a fraction of the resources of even Thailand. I appreciate the focus on public health in both Thailand and Cuba, and the ways in which healthcare is so accessible, and delivery so local. It shames the US...

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Kenneth Chester Dobson

4/27/2018 05:18:20 pm

I had an argument with a childhood friend who lived in Houston at the time (about 3 years ago) that USA healthcare was falling behind. He was enraged that I'd say US medicine was not the best in the world. I wonder if he'd still say that, but he died of an undetected heart ailment a year ago and I can't ask him.